固定的剂量与3天的负载剂量在心房的华法林启动:对INR稳定和治疗范围内的时间的影响
Sharifah Nadiah Syed Hamzah1, Shahrul Aiman Soelar2, Sabariah Noor Harun3
1Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia. shnadiah@gmail.com.
International journal of clinical pharmacy
|January 13, 2026
概括
华法林启动策略,如固定剂量或加载剂量,不会影响亚洲患者的长期抗凝剂. 早期国际正常化比率 (INR) 稳定是治疗范围 (TTR) 质量的关键,无论最初的华法林治疗方案如何.
科学领域:
- 药理学和治疗学 药理学和治疗学
- 心脏病学 心脏病学
- 临床药房 临床药房
背景情况:
- 华法林的启动通常使用固定剂量或加载剂量方案.
- 在没有基因型导向剂量的情况下,在多民族亚洲人群中比较这些策略的证据有限.
- 前庭动 (AF) 的管理需要有效的抗凝药.
研究的目的:
- 为了比较固定的剂量与3天的充满剂量华法林启动.
- 评估国际规范化比率 (INR) 稳定性和治疗范围中的时间 (TTR) 在AF队列中超过12个月.
- 评估初始INR稳定时间与抗凝质量之间的关系.
主要方法:
- 多中心,对780名先前未服用华法林的AF患者进行回顾性队列研究.
- 固定剂量 (n=501) 与3天充满剂量 (n=279) 方案的比较.
- 主要结局:TTR在3,6个月和12个月. 使用斯皮尔曼相关性和通用线性模型 (GLM) 进行分析.
主要成果:
- 时间到INR稳定与TTR有很强的反相关性 (斯皮尔曼的r=-0.600到-0.710;p<0.001).
- 未经调整的分析显示,负载剂量更快地稳定了INR,但经过对混因子进行调整后,这并不显著 (调整后的平均值:94.1 vs 104.1天;p=0.248).
- 在3,6或12个月的两个启动策略之间,调整后的TTR并没有显著差异.
结论:
- 华法林启动策略 (固定剂量与加载剂量) 在这个队列中不会独立影响长期抗凝血控制.
- 时间到初始INR稳定是12个月TTR质量的最强预测因素.
- 优先考虑早期的,密集的INR监测,特别是没有基因型导向剂量,因为临床因素显著影响结果.
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